ACUTE CHF: Rapid worsening of HF SX


  • MC in pts with hx of underlying disease

    • HTN/HF med non-compliance, fluid overload/salt intake

    • Ischemia, arrhythmia, infxn, anemia, renal failure

    • Negative inotropes (verapamil, diltiazem), NSAIDs, cocaine/etOH

  • Can occur in pts with no known hx


  • Perfusion (warm or cold)

    • Perfusing adequately ➔ warm

    • Hypoperfusion ➔ cold, shocky, AMS

      • Narrow pulse pressure,

  • Think congestion (dry or wet)

    • Not congested ➔ dry

    • Congestion ➔ wet ➔ respiratory distress, flash pulmonary edema (frothy pink sputum), crackles on auscultation, edema (RHF)


  • ↑ BNP

  • CXR can range from vascular redistribution to extensive alveolar edema

  • Hypoxemia

  • Get EKG and cardiac labs to ensure not ACS causing HF

TX - Respiratory support, diuretics, vasodilators


    • Maintaining airway (not so tired/altered they can't keep their head up)?

      • O2, 15lpm via NRB

    • Still low saturation or getting worse?

      • Non-invasive positive pressure ventilation (BiPAP/CPAP/BVM)

    • Still low saturation or getting worse?

      • Intubation

  • WET

    • Make sure pt is not hypotensive then prompt diuresis via IV furosemide (↑ dose if already on ℞)

      • Monitor output, hypokalemia/natremia, alkalosis

    • Adjunctive vasodilator: NTG, ACEi, hydralazine (monitor for hypotension)

    • Call an adult to help with inotropes and pressors in hypotensive pts d/t reduced systolic function

  • DRY

    • Typically d/t HTN or acute AR/MR ➔ vasodilator: nitroprusside (monitor for hypotension)